Most of the people I work with are comparing Medicare Advantage plans with prescription drug coverage, known as MAPD plans. There are also MA-only plans, which don’t include drug coverage, and those work well if you have VA benefits or Tricare. But for everyone else, MAPD is usually the starting point.

Understanding the Types of Medicare Advantage Plans

Medicare Advantage comes in three major forms, and each one works differently.
• HMO (Health Maintenance Organization) – This is the most restrictive type of plan. You’re required to stay in-network for coverage unless it’s an emergency. Costs are typically lower, which makes them attractive for people who want predictable spending.
• PPO (Preferred Provider Organization) – This is the most flexible option. You can see doctors outside the network, but you’ll pay more to do it. That flexibility comes with a higher maximum out-of-pocket cost.
• HMO POS (Point of Service) – This plan combines elements of both. It’s an HMO with an option for out-of-network care, but usually only with a referral. It sits right in the middle in terms of cost and freedom.

Each type has strengths and downsides, so the best plan depends on the kind of access you want and how much you’re willing to pay for it.

How Costs and Flexibility Compare

The biggest differences show up in out-of-pocket expenses.
• PPO plans give you freedom, but that freedom isn’t cheap. I see many PPO plans with max out-of-pocket limits ranging from $5,000 to over $11,000.
• HMO plans are the least flexible, but they often have the lowest costs. Their max out-of-pocket typically runs between $1,900 and $4,000.
• HMO POS plans fall in the middle. They allow limited out-of-network access at a lower cost than most PPOs.

If your top priority is access to any doctor you want, a PPO ranks first. If your top priority is saving money, HMO plans come out ahead.

Why Star Ratings Matter

Star ratings, which range from 1 to 5, measure the performance of a Medicare Advantage plan. These ratings are based on up to 40 different metrics, including:
• customer service
• member experience
• clinical outcomes
• preventive care standards
• medication management
A higher star rating usually means smoother service, better care coordination, and fewer headaches.

But star ratings aren’t the only factor. I always encourage people to consider network size, drug coverage, prior authorization rules, and the plan’s maximum out-of-pocket cost.

Ranking Plans for Access vs. Cost

When I help people compare plans, I always start by asking: Is your priority access or affordability?
Here’s how the plan types rank for access to care:

1. PPO – Most access
2. HMO POS – Moderate access
3. HMO – Least flexibility

Here’s how they rank for lowering your costs:

1. HMO – Lowest out-of-pocket
2. HMO POS – Middle range
3. PPO – Highest overall costs

There’s no universally “best” plan only the best plan for your personal situation.

Customizing the Plan to Your Needs

A Medicare Advantage plan should match your doctors, your specialists, and your medications not the other way around. Before choosing a plan, I always recommend reviewing:
• whether your preferred doctors are in-network
• which specialists require referrals
• how your prescriptions are covered
• what your estimated annual out-of-pocket costs might be
It’s also worth comparing Medicare Advantage against a Medicare Supplement (Medigap) plan if you want nationwide access without referrals. Each option has strengths, so it’s important to look at both sides before making a final decision.

Final Thoughts

Choosing a Medicare Advantage plan isn’t just about picking the cheapest option or the one with the biggest ad. It’s about understanding how each plan type works and how it fits your personal health needs. When you compare plans based on flexibility, cost, star ratings, networks, and prescription coverage, you’re far more likely to land on a plan that truly supports your well-being. My goal is always to help people make confident, informed decisions and the right Medicare Advantage plan can make all the difference

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